Risk stratification in the elderly patient after coronary artery bypass grafting: The prognostic value of radionuclide cineangiography

Supino, Phyllis G.; Wallis, James; Chlouverakis, Gregory; Borer, Jeffrey S.

doi:10.1007/bf02984088

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…The one study that did evaluate the late postoperative course of 41 patients ≥ 65 years old who had undergone ERC ≥ 1 month after CABG reported an average follow up among patients with event free survival of 8.8 years after index radionuclide assessment. 10 Of the patients, 13 died of unknown causes, five had nonfatal MIs, and five underwent late repeat CABG or percutaneous transluminal coronary angioplasty. The authors identified only LVEF at rest as being significantly predictive of survival (p<0.04).…”

Section: Resultsmentioning

confidence: 99%

Exercise Radionuclide Cineangiography for Predicting Long Term Prognosis in Elderly Post Coronary Artery Bypass Graft Patients

Shapira

Isakov

Heller

et al. 2000

American J Geri Cardiology

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ISSUE: The immediate benefits of coronary artery bypass grafting may only be transient. Recent studies which showed that exercise radionuclide cineangiography studies may predict cardiac events and survival had evaluated post coronary artery bypass grafting patients of all ages. This prospective study was done on an elderly subgroup. METHODS: The results of exercise radionuclide cineangiography performed early (4-8 months) post coronary artery bypass grafting were correlated over six years of follow up with mortality, major surgical and nonsurgical cardiac events, and cardiac event free survival in 87 consecutive patients at or above 65 years. RESULTS: The rest to peak exercise difference in left ventricular ejection fraction correlated with later cardiac death and the need for surgical interventions, while rest left ventricular ejection fraction correlated only with the latter parameter. CONCLUSIONS: Assessment of left ventricular ejection fraction at rest and at exercise has prognostic values after coronary artery bypass grafting in elderly patients. Exercise radionuclide cineangiography carried out soon after coronary artery bypass grafting might be considered an useful tool to assess patient prognosis. The efficacy of exercise radionuclide cineangiography carried out soon after coronary artery bypass grafting should be confirmed in larger and more varied patient subgroups. (c) 2000 by CVRR, Inc.

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Section: Resultsmentioning

confidence: 99%

Exercise Radionuclide Cineangiography for Predicting Long Term Prognosis in Elderly Post Coronary Artery Bypass Graft Patients

Shapira

Isakov

Heller

et al. 2000

American J Geri Cardiology

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“…4,5 Further work demonstrated that synchronicity of LV contraction could be derived from RNV by Fourier analysis of pixel by pixel labeled RBC time-activity curves, assigning a phase to each pixel (percent of the R-R interval from 0°-360°) to identify time of maximum contraction.…”

mentioning

confidence: 99%

“…2,3 Clinical trials soon showed that noninvasively determined LVEF was a strong predictor of survival in a broad range of heart diseases. 4,5 Further work demonstrated that synchronicity of LV contraction could be derived from RNV by Fourier analysis of pixel by pixel labeled RBC time-activity curves, assigning a phase to each pixel (percent of the R-R interval from 0°-360°) to identify time of maximum contraction. 6 Synchronicity has important effects on LV performance: patients with inter-or intra-ventricular asynchrony have lower LVEF relative to normal control subjects.…”

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confidence: 99%

Ventricular asynchrony: A shift to the right?

Tosh

Nichols

2017

Journal of Nuclear Cardiology

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Evaluation of ventricular function has been a focus of nuclear medicine since 1971, when Zaret et al demonstrated that abnormalities of left ventricular (LV) wall motion and ejection fraction (EF) could be determined by injection of Tc-99m human serum albumen and acquiring images at end-diastole and end-systole. Multi-gated equilibrium radionuclide ventriculography (RNV) and first-pass imaging further refined characterization of LV asynergy and performance.2,3 Clinical trials soon showed that noninvasively determined LVEF was a strong predictor of survival in a broad range of heart diseases. 4,5 Further work demonstrated that synchronicity of LV contraction could be derived from RNV by Fourier analysis of pixel by pixel labeled RBC time-activity curves, assigning a phase to each pixel (percent of the R-R interval from 0°-360°) to identify time of maximum contraction.6 Synchronicity has important effects on LV performance: patients with inter-or intra-ventricular asynchrony have lower LVEF relative to normal control subjects.7 Mechanisms for reduced ventricular performance resulting from dyssynchrony remain unclear, but Sweeney et al suggested early-contracting segments stretch and deform later-contracting ones, and vice versa, expending energy in the process, resulting in lower rate of pressure rise, lower developed pressure, prolonged ejection, and reduced EF. 8 The most ubiquitous methods to measure asynchrony are by tissue doppler echocardiographic techniques, which use low frequency signals to measure myocardial wall deformation, and calculate strain, strain rate, delay in contraction of opposing LV walls (four basal LV segments on 4-chamber view), and dispersion of time to peak systolic contraction. 9Cardiac resynchronization therapies (CRT) were designed to improve LV synchronicity through optimally timed pacing (as determined by echo) of right ventricle (RV) and LV lateral walls. CRT promotes reverse remodeling, with improved EF and survival in heart failure patients. 10 However, clinical response to CRT (defined hemodynamically or as decrease in NYHA CHF class) occurs in only two-thirds of patients, prompting efforts to identify variables that would prospectively predict a positive CRT response. Multicenter studies (''Prospect'' and ''Rethinq'' trials) demonstrated large variability in performance of echo parameters, and their failure to predict CRT response, 11,12 which fostered the development of nuclear cardiology methods for dyssynchrony assessment.One nuclear approach to quantifying asynchrony used gated myocardial perfusion imaging (GMPI) SPECT data. 13 Because of partial volume effects, myocardial wall thickening varies linearly with systolic counts, 14 so that onset of mechanical contraction (OMC) in each LV myocardial pixel was defined as increase of systolic counts from baseline. Fourier analysis generated curves of OMC phase per pixel, plotted as frequency histograms, the standard deviation (SD) and bandwidth (BW) of which were quantified. A slightly different approach that imposes constant my...

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Failure to label red blood cells adequately in daily practice using an in vivo method: methodological and clinical considerations

et al. 1995

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This study was conducted to evaluate the frequency and possible causes of poor red blood cell (RBC) labelling when performing equilibrium gated blood pool (GBP) radionuclide angiography at rest with an in vivo method. The influence of the mode of administration on tagging efficiency was studied by investigating the image quality in 160 patients referred for evaluation of left ventricular (LV) function prior to or after coronary angiography, while using a roughly standardized administration protocol. The patients were subclassified into four groups according to the way both molecules involved in the tagging procedure were administered. When poor image quality was found (in 9.4% of the patients), the labelling efficiency was quantified and the frequency of failed tagging in each group was calculated. A significant association was found between poor labelling and the use of a Teflon catheter or butterfly needle for the injection of the stannous agent. In another 737 patients, in order to avoid the problems observed in the first group, a strict administration protocol was applied to analyse the frequency of poor tagging and its possible causes. Suboptimal image quality was present in 88 patients (11.9%). Quantitatively confirmed poor tagging was present in 36 of the 88 (40.9%, or 4.9% of the whole group); the remaining 52 patients showed borderline normal labelling (> 80% bound fraction). Drug interference was studied by comparing the medications used by the 36 patients showing poor binding with those used by 44 control patients. A significant relationship was found between the use of heparin or chemotherapy and the tagging. The influence of several clinical factors on the labelling was also investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

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Risk stratification in the elderly patient after coronary artery bypass grafting: The prognostic value of radionuclide cineangiography

Abstract: Assessment of left ventricular ejection fraction at rest is prognostically useful after CABG among elderly patients. The efficacy and timing of this approach should be confirmed in further investigations with larger and more varied patient subgroups.

Cited by 6 publications

References 26 publications

Exercise Radionuclide Cineangiography for Predicting Long Term Prognosis in Elderly Post Coronary Artery Bypass Graft Patients

Exercise Radionuclide Cineangiography for Predicting Long Term Prognosis in Elderly Post Coronary Artery Bypass Graft Patients

Ventricular asynchrony: A shift to the right?

Failure to label red blood cells adequately in daily practice using an in vivo method: methodological and clinical considerations

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